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Gout
Question | Answer |
---|---|
Gout | heterogeneous disorder, deposition of uric acid salt or crystal in or ard joints and soft tissue, or crystallization of uric acid in the urinary tract |
stages of gout | 1. Asymptomatic hyperuricaemia. 2. Acute gouty arthritis. 3. Intercritical gout. 4. Chronic tophaceous gout. |
First line treatment- acute gout attack NSAIDs 1. diclofenac | 100mg start then 50mg tds for 2 days, then 50mg bds for 8 days. |
2. Naproxen | 750mg starts then 250mg tds. |
3. Indometacin | 75-100mg bds daily then reduce dose after 5 days. |
4. Piroxicam | 40mg/day start dose then reduce to 10-20mg/day |
5. Etoricoxib | - only COX2 inhibitor that licensed for gout. - 120mg OD |
Colchicine- 2nd line treatment | - given asap as the onset of symptom. - starting dose at 1mg then give 0.5mg every 2-3 hrs until pain relief. -s/e: nausea/ vomiting/ diarrhea/ abdominal pain. -max 6mg |
corticosteroid | IA injection- unlicensed prednisolone- 30mg/day for 7 days. |
Probenecid | - chronic treatment- prophylaxis - 500mg-1g BD |
Sulphinpyrazone | - chronic treatment - 100mg tds/qds |
Xanthine oxidase inhibitors- allopurinol | - 100mg initial dose and increased every 3-4 weeks as necessary. - 100-600mg. - 300mg daily reduce serum urate to normal. |
Febuxostat | - 40-80mg daily. |